Heavy Metal Mayhem
No, this isn’t about Bruce Dickinson dusting off the 747 and taking Iron Maiden on another massive world tour (which proved so successful it’s being extended though 2017). Maiden fans were pretty excited about this tour in support of the band’s first new album in five years, but it’s the scientific community who’s making the most noise about another kind of metal. Earlier this year the International Union of Pure and Applied Chemistry (IUPAC) announced that four new chemical elements will be added to the periodic table: element numbers 113, 115, 117, and 118, all four of which are classified as ‘superheavy’ metals. Even their working names—ununtrium, ununpentium, ununseptium, and ununoctium, respectively—sound like metal bands.
True to the rock’n’roll lifestyle, these elements are wildly unstable. Element 118, for example, has a half-life of .89 milliseconds, and none of the elements have any practical applications. Not ones to look a gift proton in the mouth, physicists are quick to remind us that no one knew what to do with radium when it was discovered. The Curies got a golf clap and a Nobel Prize, but it wasn’t until two decades after its discovery that radium hit peak production, being added to things like toothpaste and chocolate bars for its fun, glow-in-the-dark quality.
Indeed, the marvel here is that elements are being added at all. The IUPAC requires a rigorous confirmation process for new elements before it will consider adding them to the periodic table. Three of the four inductees were discovered over ten years ago but only recently completed the verification, so what seems like a sudden wealth of discovery was, in actuality, a decade in the making. There’s something to be said for quality control.
It was this vetting process that came to mind when looking through the upcoming changes to the ICD-10-CM codes, effective October 1, 2016. With over 1900 additions and over 700 deletions and revisions to the existing code set, the heft of this year’s update is a reflection of the partial freeze on ICD updates enacted to assist with the adoption of ICD-10 last October. Among the more noteworthy additions are diagnosis codes for Zika virus (A92.5) and prediabetes (R73.03). Clinicians seeking to diagnose either of these during the past year were relegated to using “Other specified mosquito-borne viral fevers” (A92.8) for Zika and “Other abnormal glucose” (R73.09) for prediabetes.
The National Center for Health Statistics (NCHS) of the CDC is responsible for maintaining the ICD-10-CM code set in the United States; however unlike the IUPAC, the NCHS does not have decades to luxuriate upon its changes. The speed of advancements in healthcare and medicine necessitates a near-constant evaluation of its terminology, which includes not just ICD coding but CPT® and HCPCS coding sets as well. In order to maintain the accuracy and efficiency of the ICD-10-CM, coding changes are thoroughly evaluated by a technical advisory panel with additional expertise provided by physician groups and clinical coders.
The AMA—gatekeeper for CPT codes—is no slouch in the QA department either. Proposed changes to CPTs undergo multiple stages of analysis, including a review by two separate panels comprised entirely of physicians. CMS’s Alpha-Numeric Editorial Panel goes a step further when evaluating HCPCS codes, holding public forums to allow members of the general public to present information on coding requests.
While the amount of changes across all coding sets and disparity of their governing bodies may seem daunting and disruptive to a clinic’s daily workflow, there are some easy ways to manage them. First of all, make a note of when coding sets are updated and add these dates to a clinic checklist. ICD-10 codes are updated annually on October 1st; CPT and HCPCS are updated annually on January 1st with scheduled quarterly revisions. Appoint a staff member or team to educate others on the upcoming code changes and which ones will impact the clinic the most. It’s also important remember to update any saved sets of codes, whether they’re in your EHR as a favorites list or on forms and materials used throughout the clinic.
Finally, remember these updates are overwhelmingly beneficial to both patients and clinic staff. The rapid adaptation to new technologies and methodologies ensures improved and specific documentation of patient visits, accurate assessment of quality measures, and that providers are paid appropriately for services rendered.
It’s not rock’n’roll, and it’s not radium. It’s simply good practice.